半卧截石位和左侧卧位对肛肠测压检查的影响与临床意义  

Effect of semi-recumbent lithotomy and left lateral position on anorectal manometry

作　　者：张春霞[1] 金黑鹰[1] 叶晓瑞[1] 王俊[1] 刘建磊 杨阳[1] 朱雅[1] Zhang Chunxia;Jin Heiying;Ye Xiaorui;Wang Jun;Liu Jianlei;Yang Yang;Zhu Ya(Department of Anorectal Diseases,The Second Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210017,Ji-angsu,China)

机构地区：[1]南京中医药大学第二附属医院肛肠科,江苏南京210017

出　　处：《结直肠肛门外科》2020年第4期464-468,共5页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨半卧截石位与左侧卧位进行肛管直肠测压结果的差异。方法纳入2018年11月至2019年3月在南京中医药大学第二附属医院肛肠中心进行肛肠测压的66例患者作为研究对象,其中46例因便秘就诊,20例因肛门坠胀或肛门疼痛就诊。患者先进行左侧卧位检查,检查结束后休息10 min再进行半卧截石位检查。比较两种体位的肛肠测压仪器各通道(P1~P7)检测数据,以P1~P4作为直肠压力,以P5~P7作为肛管压力。结果静息时,左侧卧位P1、P2、P3低于半卧截石位,P6高于半卧截石位(均P<0.05)。收缩时,左侧卧位P1、P2、P3低于半卧截石位,P4、P5、P6高于半卧截石位,左侧卧位P1收缩压增加值低于半卧截石位,P3、P4、P5、P6收缩压增加值高于半卧截石位(均P<0.05)。持续收缩时,左侧卧位P1、P2、P3低于半卧截石位,P5、P6高于半卧截石位,左侧卧位P1、P4持续缩榨压力增加值低于半卧截石位,P5、P6持续缩榨压力增加值高于半卧截石位(均P<0.05)。力排时,左侧卧位行肛肠测压提示64例符合盆底失弛缓1型,2例未能诊断盆底失弛缓;半卧截石位行肛肠测压时提示57例符合盆底失弛缓1型,3例符合盆底失弛缓3型,6例未能诊断盆底失弛缓;左侧卧位P1、P4力排时的压力变化值高于半卧截石位(均P<0.05)。两种体位的首次感觉、首次便意、强烈便意阈值比较,差异均无统计学意义(均P>0.05),左侧卧位最大耐受容量高于半卧截石位(P<0.05)。所有患者的肛门直肠抑制反射在两种体位均能正常引出。结论左侧卧位的部分直肠压力指标及变化值总体呈现低于半卧截石位的现象,而部分肛管压力指标则一定程度上表现出高于半卧截石位的趋势,临床应重视肛管直肠测压的体位对结果数据判读可能带来的影响,相比之下,半卧截石位可认为更接近自然排便时的生理体位。Objectives To investigate the influence of semi-recumbent lithotomy and left lateral position on anorectal manome⁃try.Methods Sixty-six patients who received anorectal manometry at the Center of Anorectal Diseases,the Second Affiliated Hospital of Nanjing University of Chinese Medicine between November 2018 and March 2019 were recruited.Of these patients,46 patients presented with constipation,and 20 patients suffered from anal bulging or pain.Patients underwent the test with a left lateral position at first.After 10 minutes of resting,the test was repeated with a semi-recumbent lithotomy position.We com⁃pared data of the anorectal manometry from the seven passage(P1~P7)obtained with the two positions.P1~P4 represent rectal pressure,and P5~P7 represent anal pressure.Results For resting pressure,P1,P2,and P3 were lower,while P6 was higher with left lateral position than with semi-recumbent lithotomy position(P<0.05).For squeeze pressure,P1,P2,and P3 were lower,while P4,P5,and P6 were higher with left lateral position(P<0.05).The squeeze increment of P1 was lower,and the squeeze increments of P3,P4,P5,P6 were higher with left lateral position(P<0.05).For continuous squeezing,P1,P2,and P3 were low⁃er,P5 and P6 were higher with left lateral position,the squeeze increment of P1 and P4 were lower,P5 and P6 were higher with left lateral position(P<0.05).During attempted defecation,anorectal manometry with left lateral position showed 64 cases of type 1 pelvic floor dyssynergia,two patients did not fulfill the criteria for pelvic floor dyssynergia;anorectal manometry with semi-recumbent lithotomy position showed 57 cases of type 1 pelvic floor dyssynergia,3 cases of type 3 pelvic floor dyssynergia,and six patients did not fulfill the criteria for pelvic floor dyssynergia.Changes in P1 and P4 during attempted defecation were higher with left lateral position than with semi-recumbent lithotomy position(P<0.05).There were no between-group differences in first sensation,desire to defecation,and urgency(P>0.05).The maxi

关 键 词：盆底疾病 肛肠测压 半卧截石位 左侧卧位 

分 类 号：R574[医药卫生—消化系统]